Prescription Opioid Use: An Assessment of Social Factors and Birth Cohort Trends


Shiue, Kristin Y. (2023). Prescription Opioid Use: An Assessment of Social Factors and Birth Cohort Trends.


The relentless rise in drug overdose deaths in the United States underscores the urgent need to broaden the scope of the current response and prioritize approaches that address the social and structural drivers of opioid-related outcomes. As foundational work to advance our understanding of the dynamics underlying the opioid crisis, this dissertation had two aims: (1) identify upstream individual- and contextual-level social factors associated with prescription opioid use, with factors encompassing five domains (economic stability, social/community context, health care access/quality, education access/quality, neighborhood/built environment); (2) quantify the separate influences of age, period, and cohort on longitudinal trends in prescription opioid use.

Leveraging available data from two large longitudinal cohort studies, the National Longitudinal Study of Adolescent to Adult Health (n=14,800) and the Johnston County Osteoarthritis Project (n=785), multivariable logistic regression models were used to estimate associations between social exposures and prescription opioid use among young adults (Add Health) and middle-aged to older adults (JoCoOA) across multiple study timepoints during 2001-2019. Lower individual-level educational attainment was associated with increased odds of prescription opioid use for all timepoints assessed. Poorer social support across age groups and unemployment among middle-aged to older adults were also associated with increased opioid use.

To characterize longitudinal trends in prescription opioid use, an age-period-cohort analysis was conducted using National Health and Nutrition Examination Survey data (1999-2018; n=63,500). Prescription opioid use increased across the lifespan, with steeper increases from young- to mid-adulthood. Period-related variation was consistent with nationwide shifts in opioid prescribing. There was no evidence of systematic cohort effects, suggesting that prescription opioid use during 1999-2018 was largely driven by age and period influences.

The circumstances contributing to prescription opioid use throughout the lifespan and during the overdose crisis are complex, highlighting the need for continued efforts to monitor opioid use in the context of the ever-evolving overdose crisis. This work identified educational attainment and social support as key social factors related to prescription opioid use that require our focus for further in-depth investigation and exploration of intervention approaches, such as those aimed at promoting education access and fostering social connection, which altogether may influence opioid-related outcomes.



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Shiue, Kristin Y.

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University of North Carolina at Chapel Hill

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